Feasibility of Dialectical Behavior Therapy with Suicidal and Self-Harming Adolescents with Multi-Problems: Training, Adherence, and Retention

Abstract

We evaluated the feasibility of DBT training, adherence, and retention preparing for a randomized controlled trial of Dialectical Behavior Therapy (DBT) adapted for Norwegian adolescents engaging in self-harming behavior and diagnosed with features of borderline personality disorder. Therapists were intensively trained and evaluated for adherence. Adherence scores, treatment retention, and present and previous self-harm were assessed. Twenty-seven patients were included (mean age 15.7 years), all of them with recent self-harming behaviors and at least 3 features of Borderline Personality Disorder. Therapists were adherent and 21 (78%) patients completed the whole treatment. Three subjects reported self-harm at the end of treatment, and urges to self-harm decreased. At follow up, 7 of 10 subjects reported no self-harm. DBT was found to be well accepted and feasible. Randomized controlled trials are required to test the effectiveness of DBT for adolescents.

Outpatient Dialectical Behavior Therapy for Adolescents Engaged in Deliberate Self-Harm: Conceptual and Methodological Considerations

“…This trend was observed in four of the reviewed studies (Fleischhaker et al, 2011; Mehlum et al, 2014; Rathus & Miller, 2002; Tørmoen et al, 2014). The two additional studies (James et al, 2014; Woodberry & Popenoe, 2008) noted that subjects demonstrated symptoms consistent with BPD (i.e.…”

“…Four studies utilized a non-control group preand post-test comparison design; two included extended post-treatment follow-up (Fleischhaker et al, 2011; James et al, 2014; Tørmoen et al, 2014; Woodberry & Popenoe, 2008) and two studies included a comparison group (Mehlum et al, 2014; Rathus & Miller, 2002). Mehlum et al (2014) was the only randomized control trial study utilizing a usual care as the control condition.…”

“…Variations have been shown to obscure past results, causing disparity (Muehlenkamp et al, 2012). Of the six studies in this review, three relied on behavioral counts of DSH episodes per week or across sessions (Mehlum et al, 2014; Rathus & Miller, 2002; Tørmoen et al, 2014). Although the LPC was used in three studies, only Fleischhaker et al (2011) used this measure as a pre-test post-test outcome measure.…”

Tagesklinische dialektisch-behaviorale Therapie: Eine Verlaufsuntersuchung nach Entlassung. Gibt es Prädiktoren für eine Verschlechterung?

“…In den letzten Jahren wurden Adhärenz und therapeutische Allianz als wichtig für einen guten Therapieerfolg beschrieben [Priebe et al, 2012;Tormoen et al, 2014]. Zu diskutieren ist, ob sich in unserer Risikogruppe, charakterisiert durch hohe «Dysphorie», die therapeutische Allianz gegebenenfalls vermindert hat und damit Therapieerfolge möglicherweise reduziert wurden.…”

Non-Suicidal Self-Injury in Swedish Adolescents : Prevalence, Characteristics, Functions and Associations With Childhood Adversities

“…The most often referred treatments are Mentalization Based Treatment for Adolescents (MBT-A) (Laurenssen et al, 2014;Rossouw, 2013;Rossouw & Fonagy, 2012) and Dialectical Behavior Therapy for Adolescents (DBT-A) (Fleischhaker et al, 2011;Katz, Cox, Gunasekara, & Miller, 2004;MacPherson, Cheavens, & Fristad, 2013;McDonell et al, 2010;Miller, Rathus, & Linehan, 2007;Rathus & Miller, 2002;TØrmoen et al, 2014). However, these methods are extensive, not always feasible in clinical practice and treat NSSI in a BPD context.…”